Long-term results after vascularised joint transfer for finger joint reconstruction

Heterotopic Vascularized Joint Transfer in Mutilating Hand Injuries

“…The first vascularized joint transplantation was reported in 1967 by Buncke et al 10 ; later authors continued to recommend and revise the technique because it provides a functional joint in a single stage, incurs no donor site morbidity, and makes use of otherwise discarded tissue. [6][7][8][9] Heterotopic joint transfer is a technique that can reverse the functional fate of an injured digit and help recover prehensile function in the mutilated hand. [7][8][9][10][11][12][13][14][15][16][17][18][19] Based on our experience, there are four general categories of choices to be made in heterotopic vascularized joint transfer.…”

“…The MPJ and PIPJ are responsible for most of a digit's ROM, whereas the point of DIPJ preservation is typically to preserve length, and therefore motion is not as significant a concern. 12 Hierner and Berger 6,20,21 proved that there was no significant difference in results between toe joint and heterodigit joint transplantation. Based on our experience, we can classify the heterotopic joint transfer as same level joint transfer, distal to proximal joint transfer, and proximal to distal joint transfer.…”

“…8 Various authors have since presented their series, further supporting the efficacy of this technique. [6][7][8][9] In addition, Hierner and Berger and Mishra et al [6][7][8][9][10][11] independently demonstrated that ROM achieved with heterotopic vascularized joint transfer was equal or greater than that compared with toe joint transfer. However, although several papers have described the technique and its outcomes, there is little discussion or analysis of the strategies involved in executing the technique.…”

“…These parts can then be assembled in combinations that maximize function while minimizing donor sites and associated morbidity. 5,6 Of the parts that the surgeon must consider for salvage or reconstruction, the proximal interphalangeal joints (PIPJ) and metacarpophalangeal joints (MPJ) are particularly important for digital function and particularly difficult to reconstruct if damaged or lost. If an amputated digit is replanted with a significantly damaged MPJ or PIPJ, long-term function will be severely limited and may require multiple revision procedures and eventually delayed amputation.…”

Improving the Extensor Lag and Range of Motion following Free Vascularized Joint Transfer to the Proximal Interphalangeal Joint

“…3 Over the decades, however, vascularized joint transfers have remained relatively unpopular because of the disappointingly low range of motion typically achieved after transfer, with most series reporting an average total range of not more than 40 degrees. 2,4,5 In their systematic comparison of different methods for proximal interphalangeal joint reconstruction, Squitieri and Chung 6 found a significantly lower range of motion of 37 ± 9 degrees following vascularized joint transfer as compared with implant arthroplasty with either the PyroCarbon or Swanson prosthesis for reconstruction of the proximal interphalangeal joint. As compared with vascularized joint transfer for other joints in the hand, Foucher et al 7 also reported that the worst range of motion occurred when using transfers of the toe proximal interphalangeal joint for finger proximal interphalangeal joint reconstruction, with an average range of motion of 23 degrees.…”